Faculty Bibliography

A hip click on examination of the newborn hip is believed to be the result of a ligament or myofascial structure and thought to be benign. Some studies suggest a link between hip clicks and developmental dysplasia of the hip. The purpose of our study is to estimate the prevalence of ultrasound hip abnormalities in newborns with a hip click and an otherwise normal physical examination. Results. Ninety patients meeting inclusion criteria of a hip click with an otherwise normal physical examination underwent diagnostic ultrasound with a 17.8% prevalence of hip abnormalities found (95% confidence interval ±7.9% [range of 9.9% to 25.7%]). Our study had 64 (71%) females and 26 (29%) males. The prevalence of hip pathology for females was 18.8% (12 of 64 patients) and for males was 15.4% (4 of 26 patients). Thirty-three patients were found to have bilateral hip clicks on presentation, with 21.2% (7 of 33) of those patients found to have hip pathology on ultrasound (3 of the 7 had pathology of both hips). Six patients had a family history of hip dysplasia and 1 of these patients (16.7%) had pathology on ultrasound. The average age to hip sonography was 6.6 weeks. Conclusions. In all, 17.8% of newborns with a hip click were found to have hip abnormalities on ultrasound. The prevalence of hip pathology, on ultrasound, suggests that additional larger, prospective studies are needed to clarify the association between a hip click and abnormal ultrasound found at 6 weeks of age or greater.

Introduction/UNASSIGNED:Unplanned office visits due to cast-related problems in the pediatric orthopedic office are common. Decreasing problems associated with the use of a cast would improve patient safety, increase office productivity, and decrease inconvenience to the child and family. Methods/UNASSIGNED:Pediatric patients treated with a cast in our office were included in the study if they returned for an unplanned office visit due to a cast-related problem. Group 1 received verbal cast care instruction. Group 2 had the same verbal instruction in addition to a written handout identical to the verbal instructions. Group 3 was provided the same verbal instructions and a revised handout limiting the number of instructions and focused on keeping the cast away from water. Results/UNASSIGNED:The study included 550 patients with 146 in group 1, 124 in group 2, and 280 in group 3. Comparing group 1 (10.3%) and group 2 (10.5%), there was almost no difference in the rate of unplanned office visits due to cast-related problems. Combining the revised handout with verbal instructions in group 3, the percentage of patients returning for an unplanned visit was 6%. There was a relative decrease in office visits by 55% and an absolute decrease of 4.5% when comparing group 2 and group 3. Conclusions/UNASSIGNED:There was a decrease in the number of unplanned office visits due to cast problems utilizing a handout focused on keeping the cast dry in collaboration with verbal cast care instructions. However, the decrease was not statistically significant.

Hoverboards burst onto the scene with wide popularity only to be quickly deemed unsafe and banned in many arenas. We conducted a retrospective cohort study of 35 patients seen in our outpatient pediatric orthopedic office over a 1-year period. The mean age of injured patients was 11.14 years; 18 patients were male (51.4%), and 17 were female (48.5%). The highest number of injuries occurred in children 10 to 14 years old who had 57.1% of the injuries. There were a total of 31 fractures in 27 patients. Most of the fractures were in the upper extremities (93.6 %). Also, 9 soft-tissue injuries were found in 8 patients; 88.9 % of injuries occurred in the upper extremities. Most of the injuries were secondary to a fall (94.3%). We found that the most common injury was upper-extremity fracture. We suggest restricting riding <16 years and encourage protective equipment, especially elbow and wrist guards.

BACKGROUND:This is a literature review generated from The Committee on Trauma and Prevention of Pediatric Orthopaedic Society of North America to bring to the forefront 4 main areas of preventable injuries in children. METHODS:Literature review of pertinent published studies or available information of 4 areas of childhood injury: trampoline and moonbouncers, skateboards, all-terrain vehicles, and lawn mowers. RESULTS:Much literature exists on these injuries. CONCLUSIONS:Preventable injuries occur at alarming rates in children. By arming the orthopaedist with a concise account of these injuries, patient education and child safety may be promoted. LEVEL OF EVIDENCE/METHODS:3.

BACKGROUND:The purpose of this study was to determine the average prevalence of children across the nation who experience difficulty in attending school after an acute orthopaedic injury. METHODS:A survey was created to obtain information on school absence for children with acute orthopaedic injuries. All members of the Pediatric Orthopaedic Society of North America were invited to complete the survey. RESULTS:The survey was sent by e-mail to 936 members of the Pediatric Orthopaedic Society of North America. A total of 283 surgeons from 45 states responded to the survey, which resulted in a response rate of 30.2%. The survey found a correlation with difficulty in attending school with a cast and the size of the population served. Communities with the larger populations are less likely to permit children to attend school with a cast. The most common reasons given by schools for a child not being permitted to attend school with a cast were concern for the safety of the child and inability to accommodate the needs of the child. CONCLUSIONS:Most physicians participating in the survey reported no difficulty with their patients attending school with a cast. There was more difficulty with children in attending school with a cast in metropolitan areas and in communities with greater than 1 million people. To decrease or to eliminate absence from school, it may be best to identify schools in a physician's community that do not allow attendance of children with a cast. Once individual schools are identified, advocacy can be targeted. At the very least, when it is known which schools are involved, the surgeon can anticipate difficulties and plan accordingly. As a child's absence from school has substantial negative consequences, we strongly support intervention to enable injured children to appropriately return to a regular educational setting in a timely manner. Future studies with school participation would help to identify reasons for school absence after a musculoskeletal injury. LEVEL OF EVIDENCE/METHODS:Level V, Prognostic.

The extension-type pediatric supracondylar humerus fracture accounts for nearly two-thirds of all pediatric hospitalizations due to elbow trauma. The Gartland classification guides the standard of care for treatment of this entity. Type I injuries are treated with cast immobilization while type II and III injuries are treated operatively. The reported interobserver reliability ranges from moderate to full agreement, which is on par with other frequently referenced classification systems such as Lauge-Hansen for adult ankle fractures. In this study, 4 fellowship-trained pediatric orthopedic surgeons reviewed radiographs of 72 pediatric supracondylar fractures and classified them based on Gartland's system. They recommended their preferred treatment of cast immobilization for type I fractures and of closed reduction and pinning in the operating room for type II and type III fractures. The interobserver and intraobserver reliability for each set of radiographs was then analyzed. There was moderate agreement comparing all fractures and comparing types I and II fractures, while there was full agreement for type III fractures. There was full agreement for the intraobserver reliability. The preferred treatment (casting vs operative intervention) differed in 35% of patients, if based on the fracture classification.

BACKGROUND:The purpose of this study is to investigate the relationship between children who sustain tibia fractures on a playground slide and the mechanism of injury. METHODS:This retrospective review included the chart and radiographs of all children diagnosed with a tibia fracture, over an 11-month period. All patients were originally seen in either the emergency room of a level 1 trauma center or the treating physician's office. RESULTS:During the period of study, 58 fractures of the tibia were found. Eight (13.8%) of the tibia fractures were sustained while playing on a playground slide. The 8 fractures identified are the focus of this study. The tibia fractures were nondisplaced, diaphyseal, with an intact fibula. There were 5 female and 6 male children included in the study. The age range of the patients with a tibia fracture sustained while going down a slide was 14 months to 32 months; the average age of the 8 children in this study was 20.6 months. The average age of boys sustaining a tibia fracture on a playground slide was found to be 20.7 months and the average age of girls was found to be 20.6 months. All tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult. None of the 8 children studied went down the slide alone. CONCLUSIONS:Children at risk for tibia fractures sustained while going down a playground slide, on the lap of an adult, were found to be less than 32 months of age. Many parents believe they are increasing the safety of their young child by placing the child on their lap while going down a playground slide. Parents should be educated not to go down a slide with a child on their lap. If the child is unable to use the slide independently, another activity would be more appropriate. LEVEL OF EVIDENCE/METHODS:Therapeutic study, level IV.

This case report of a neonate who developed an acute compartment syndrome secondary to a minimally displaced distal tibial physeal injury represents the youngest patient to be reported with such a condition. After undergoing emergency four-compartment decompression fasciotomies, the 4-week-old child had a return of normal neuromuscular function and anatomic remodeling of the fracture. It is difficult to diagnose compartment syndrome in a neonate. The patient can neither give a history, nor follow commands to cooperate with the exam. The physician must rely primarily on the physical examination; however, the quantitative measurement of intracompartmental pressure can corroborate the diagnosis of compartment syndrome. We have found using a monometer to measure intracompartmental pressure to be helpful in conjunction with a physical exam when evaluating a neonate suspected of having a compartment syndrome.